12 CCR 2509-2
7.100 PROGRAM FOR THE PROTECTION OF AT-RISK ADULTS UNABLE TO PROTECT THEIR
OWN INTERESTS
7.101 PROGRAM DEFINITION
This program is designed to intervene with or on the behalf of at-risk adults to correct or alleviate situations in which actual or imminent danger of abuse, neglect, or exploitation exists and to utilize support systems to provide continuing safety from the incident(s) of abuse, neglect, or exploitation.
7.102 DEFINITIONS
The definitions set forth in Section 26-3.1-101 C.R.S., as amended, shall apply to these regulations.
7.103 TARGET POPULATION
A. At-risk adults 18 years of age and older who are unable to protect their own interests, and who are:
1. In need of assessment for protection or in need of short term services due to a report of actual or potential neglect, abuse, or exploitation. (Such at-risk adults may shall receive services for up to six months.)
2. In need of ongoing protection as the result of documented evidence of neglect, abuse, or exploitation. Such at-risk adults shall receive protective services for as long as the possibility of abuse, exploitation and/or neglect continues.
B. At-risk adults for whom the county department has guardianship or conservatorship.
C. At-risk adults for whom the county department is the representative payee.
D. Residents of long term care facilities (nursing homes, alternate care facilities, adult foster care, personal care boarding homes) who must be relocated due to the closure of the facility.
7.104 Services to at-risk adults in this program are provided without regard to income or resources.
7.105 INTAKE
A. County department staff shall receive training in how to secure required intake information, conduct thorough assessments, and provide appropriate ongoing adult protective services B. The county department shall receive oral or written reports of at-risk adult mistreatment and/or self neglect.
C. The county shall make a written record of all such reports within 48 hours of the receipt of these reports, using a form prescribed by the state, or a county form which has been approved by the state.
D. Within 24 hours of the completion of written reports, the county shall forward copies of reports to the local offices of the district attorney and law enforcement.
E. The county shall keep a record of all reports of the mistreatment and/or self neglect of at-risk adults which are forwarded to the county by the local law enforcement agency.
F. In conjunction with local law enforcement agencies, and/or the office of the district attorney, the county department shall develop cooperative agreements regarding the investigative duties of the two agencies. These agreements shall include a protocol for joint investigations, as well as the provision of special assistance upon the request of one agency by the other. The focus of these agreements shall be to provide the best protection to at-risk adults.
7.106 ASSESSMENT
A. Upon receipt of any initial report of mistreatment or self neglect of an at-risk adult, in addition to the generic provisions as contained in Sections 7.001.3 and 7.001.6, county department staff shall:
1. Determine if the client is known to the department and review available information.
2. Develop initial contact strategy based upon client circumstances (e.g., involvement of local law enforcement, the district attorney, other community agencies, or relatives, timing of contact, etc.).
3. When the report indicates that there is a possibility of immediate physical harm to the victim, due either to the severity of the abuse, or the physical frailty/ vulnerability of the victim:
4. For all other reports which do not appear to involve immediate physical harm to the victim, county department staff shall make a face-to-face contact with the at-risk adult within three working days of the receipt of the report, or document in the case record the reason(s) why a face-to-face contact was not possible.
5. Open the case for assessment services if the case is not currently open.
6. Evaluate and document the following areas at time of initial assessment:
7. Seek the assistance of law enforcement agencies, or seek court action in order to gain admittance in emergency situations when access to an individual's residence or location is denied.
8. Cooperate with law enforcement officials in receiving and investigating reports of possible abuse, neglect, or exploitation of adults.
9. Involve other agencies when their services are needed in the assessment phase and follow up to ascertain what action was taken.
B. Cases not requiring additional protective assessment or ongoing intervention will be closed within 60 calendar days of decision. Closing will include a summary dictation documenting reason for non- intervention and closure.
C. When the assessment results in a determination of client risk of mistreatment and/or self neglect, the case shall remain open for the provision of ongoing adult protection services for as long as the risk to the victim continues.
7.107 CASE PLAN FOR ONGOING PROTECTIVE SERVICES
A. The case plan shall include a problem statement which describes:
1. Client risk.
2. Reason client is unable to act on own behalf.
3. Person(s) or situation causing client risk.
4. Type of protective problem(s) (i.e., abuse, neglect, exploitation).
B. The case plan shall include a plan for intervention.
1. The plan shall address the specific strategy of intervention which will be used to reduce client risk.
2. The plan shall be implemented observing the following principles:
3. The plan shall specify the roles of the worker, client, community agencies, and informal support systems in reducing client risk.
4. Ongoing protective services shall be provided to at-risk adults who consent to the provision of such services either verbally or in writing. If client's written consent to the provision of ongoing protective services is unobtainable, county staff shall document the reason in the case plan.
5. The case plan shall include the purpose of intervention which describes how implementation of the plan is expected to reduce or eliminate specific elements of risk.
6. Frequency of Client Contact
7.108 EVALUATION OF SERVICE DELIVERY
A written evaluation of the effectiveness of services provided as described in the case plan and redetermination for services eligibility shall be accomplished at least every six months. The content of the evaluation shall include:
A. The current level of client risk of continued abuse, exploitation and/or neglect, and how the activities of the caseworker, client, community agencies and informal supports have reduced client risk.
B. How the services being provided are in keeping with principles of client self-determination, use of the least restrictive alternatives, and involvement of the client, family, and other informal supports in the case plan activities.
C. Frequency of client contacts.
D. What goals of the case plan have been achieved.
E. What goals of the case plan have not been achieved, and the reasons.
F. What is the plan and time frames for achieving these remaining goals.
7.109 REASSESSMENTS
Adult protective services shall be reassessed at least every six months for continuing incapacity and risk, or to establish reasons for case closures.
7.110 REASONS FOR CASE CLOSURE UNIQUE TO ADULT PROTECTION
A. Case closure may occur when:
1. The assessment uncovers situations of actual or potential abuse, neglect, or exploitation and the client is competent to make rational decisions in this area but refuses services. Such situations shall be documented in the case record. Whenever possible, a signed statement shall be obtained from the client affirming that he/she is aware of the situation which places him/her at risk, the possible consequences if the situation continues, and the fact that, despite this understanding, the client does not wish to receive additional adult protective services at this time.
2. Repeated efforts at service delivery have proven ineffective and no additional alternatives exist. This must be documented in the case record.
3. See General Rules Section 7.001.7 for other possible reasons for case closures.
4. Upon the death of a protective services client, the case may remain open for as long as activities relating to the settlement of the client's estate continue. Such activities must be documented in the case record.
B. At the time of case closure, a final written summary shall be made in accordance with Section 7.002.1.
7.111 COMMUNITY AT-RISK ADULT PROTECTION TEAMS
A. The director of each county department is encouraged to convene and coordinate a community at-risk adult protection team.
B. The roles of such teams are information sharing and problem solving regarding issues of at-risk adult protection which may be of community concern.
C. The goals of such teams include:
1. Facilitating interagency cooperation regarding services to at-risk adults; and/or, 2. Reviewing the procedures developed for the investigation of reports of mistreatment or neglect of at-risk adults; and/or, 3. Reviewing the provision of protective services to at-risk adults; and/or, 4. Developing/providing information to the community at large regarding issues of adult protection.
D. The goals of each community adult protection team are to be developed by the team itself, using the guidelines listed above, and taking into consideration the most compelling needs of the community conceming adult protection issues.
E. Composition of the Team 1. Interested individuals and representatives of the following agencies/professions may serve on the team: Mental Health, health care providers; hospital discharge planners; law enforcement; visiting nurses; physicians; private attorneys; long term care ombudsmen; banks; senior centers; legal services; district attorneys; alcohol treatment; public housing; long term care providers; area agencies on aging; community center boards; social services; as well other special interest groups.
2. The director of the county department shall initially identify those agencies and/or individuals who would have the greatest interest in adult protection issues, and would be willing to serve on the team.
3. An established team shall develop and adopt written by-laws regarding purpose, membership, terms of office, frequency of meetings, leadership and confidentiality.
4. Each team member shall be advised of the confidential nature of his/her responsibilities in accordance with Section 26-3.1-102 (a), (b), (c), C.R.S.
5. Membership on the team shall may be either by appointment of the agency to be represented, or by appointment of the county director, or by the county commissioners.
7.112 INTERCOUNTY CASE TRANSFERS (Also see County Responsibility in General Information and Policy, Section 7.000)
A. Within 15 working days after the county learns that a protective service client has relocated in a new county, the county of former residence shall request an assessment visit be made by the new county. If additional information is requested by the new county prior to making the face-to-face client assessment visit, the former county must comply within 15 working days. The new county has 15 working days after receipt of the requested information to complete the assessment visit, providing that the client can be located. If, after repeated, and documented efforts, the client cannot be located, the receiving county shall notify the county of former residence of this fact, and close the case.
B. In circumstances where one county has guardianship/conservatorship and the client relocates to another county, guardianship/conservatorship may remain with the first county and services shall be provided by the second county.
C. In all situations where the client moves out of the county, case record information shall be supplied to the new county within thirty working days from the day of the receiving county's request.
D. When a county department having been appointed representative payee learns that the client has moved to a new county, the county of former residence shall notify the new county of the existence of the appointment and a decision shall be made by the county of residence regarding acceptance within 30 working days.
E. If a client for whom the county department has guardianship or conservatorship moves to another county, either county may, with the agreement of the receiving county, upon mutual agreement, petition the court for a transfer of guardianship/conservatorship to the receiving county.
7.113 ALTERNATIVE LIVING ARRANGEMENTS
A. Unless client has been adjudicated by the court as an incapacitated person, the final decision as to alternative living arrangements shall rest with the client.
B. Cases in which the client is relocated to a nursing home may remain open for evaluation of the continuing need for this level of care for no longer than six months, unless:
1. The resident is being seen monthly by a local long term care ombudsman, in which situation, the case is to be closed within 30 working days of a documented client visit by the ombudsman. Nursing home relocation shall be accomplished in compliance with procedures established by the Professional Review Organization (PRO), and/or the State Nursing Home Relocation Plan, or 2. The county department has a court ordered guardianship or conservatorship, or is acting as the representative payee, in which situation, the case shall remain open for the duration of the court order, or for as long as the county continues to act as representative payee.
C. In all other changes in living arrangements, except nursing homes, an evaluation of need for continuing protective services shall be completed. If no documentable need exists, the case shall be closed or assigned another program area designation.
7.114 COURT SANCTIONED INTERVENTION
A. The following statutes are available for court sanctioned intervention in adult protective cases:
1. Adult Protection (Article 3.1 of Title 26, C.R.S., as amended).
2. Probate Code (Article 14 of Title 15, C.R.S., as amended), (Guardianship/Conservatorship).
3. Institutions Code (Articles 9 of 10 of Title 27, C.R.S., as amended), (Mental Health).
4. Health Code (Article 1 of Title 25, C.R.S., as amended), (Alcoholism-Intoxication Treatment).
5. Representative (substitute) Payee for Social Security (20 CFR 404 - 1601 et seq.).
6. Power of Attorney (Article 14 of Title 15, Section 104, C.R.S., as amended).
B. Prior to reaching a decision to petition for court intervention, the following factors shall be investigated and documented:
1. No other method of intervention will meet the clients needs.
2. The degree of incapacity warrants this action as supported by medical or psychiatric evidence.
3. The type of court intervention sought (e.g., Protective Order, Guardianship, etc.) shall be the least restrictive action required to meet the needs of the client.
4. County departments shall actively seek out responsible parties such as family or close friends to petition the court and to carry out the orders of the court.
5. In the absence of other responsible parties to act on behalf of a disabled adult, county departments are strongly urged to accept guardianship and/or conservatorship.
6. The county department shall consult with an attorney prior to filing a petition.
7. When petitioning the court for protective action, the county department shall provide all information deemed necessary by legal counsel.
8. At the time of the hearing of the petition, the representative of the county shall be prepared to testify in support of the petition.
9. When a county department is appointed by the court to act on behalf of an incapacitated adult, certified copies of the letter of appointment shall be obtained.
10. The county department must understand the powers and duties as set forth by court order.
11. The county department shall submit at least annually, a written report to the court accounting for all actions taken on behalf of the client in fulfilling the duties set forth in the court order.
12. The county department shall petition the court to vacate the court order at such time as court ordered intervention is no longer necessary or the county department is no longer able to fulfill the obligations of the role assigned by the court.
13. The county department shall involve the court in the development procedures for the handling of critical (life threatening) situations which require immediate action.
7.115 PROTECTIVE SERVICES OPTIONS FOR LONG TERM CARE SERVICES CLIENTS
A. County departments shall accept all referrals for assessment of need for protection made by the case management agency and follow the procedures in this chapter.
B. County departments shall report back to the referring case manager within five working days the findings of the preliminary investigation.
C. The county case worker shall maintain regular communication with the case manager concerning options for long term care services clients who require protective services.